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General NPI Number Information
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NPI Number | 1922278704
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Entity Type | Organization
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Legal Business Name | BROOME VISION INC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 701 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5331
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Country | US
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Telephone | 386-253-5999
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Fax | 386-253-1193
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Provider Business Mailing Address
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Address Line | PO BOX 351
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City | DAYTONA BEACH
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State | FL
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Zip | 32115-0351
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Country | US
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Telephone | 386-253-5999
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Fax | 386-253-1193
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. KEVIN A BROOME
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Credential | OD
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Telephone | 386-253-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3301
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License Number State | FL
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